Permit CITY TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR2003 -00124
"AI�� DEVELOPMENT H BMENg Tigard, SERVICES 639 -4171 DATE ISSUED: 8/19/03
SITE ADDRESS; 12245 SW THORNWOOD DR PARCEL: 2S110BC -05400
SUBDIVISION: THORNWOOD ZONING: R -
BLOCK: LOT: 025 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF.
Owner: FEES
DON MORISSETTE HOMES INC
4230 GALEWOOD STE #100 Description Date Amount
LAKE OSWEGO, OR 97035 [ SWINSP] Swr Inspect 8/19/03 $35.00
[SWINSP] Swr Inspect 8/19/03 $0.00 .
Phone: 503 387 - 7538 [SWUSA] Swr Connect 8/19/03 $2,400.00
[SWUSA] Swr Connect 8/19/03 $0.00
Contractor:
Total $2,435.00
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Perm
Is ued by: _! %1_� ``� ..� . Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day